If you read my stuff, you understand that it is pretty eclectic. One week, I may experiment with adding TVP in a meatloaf; the next, I’ll ponder whether God exists; and the following, I’ll explore why I am the way I am.
The blog has never had a commercial purpose. I’m just a guy with a thousand interests, and I enjoy writing. I often tell my kids, “If this post makes a single person think about the topic, then that is a bonus for me.” However, the pure enjoyment of putting thoughts on paper is my primary motivator. Many people have told me repeatedly that more people would read my work if I shortened my posts. Very true, but what is the fun in that?
Often, my posts are stream-of-consciousness, but sometimes, I feel the need to push my personal envelope and explore a topic further. Like many, I dip into social media sites, including YouTube.
About a month ago, YouTube’s “For You” page featured a video about relationships. I can’t remember the exact title, but it was something like “What Men Need To Know About Women.” I clicked on it, which sent me down a rabbit hole of other men-centered videos, including many “Red Pill” ones. When you watch a concentration of them, they start to mess with your mind, and I felt I needed a balance, so I deliberately forced the algorithm to give me more female-perspective videos. These were equally horrifying.
Men bashing women, women bashing men, women treating men like objects to be exploited, men categorizing women along extremely narrow lines. It was pretty horrible. As an expert in behavior, I understand that these curated videos can significantly impact viewers, creating biases and prejudices that can have lasting adverse effects in the real world. I decided I had to write about it, but I couldn’t. I didn’t want to spread what I felt were false narratives. I wanted to offer an observation that would counter the rhetoric. Were people actually ascribing to this stuff?
I decided to approach the topic obliquely. I would write a more general post on the dangers of curated media, which I did on December 3rd. I then opted to focus on the forces of change in our society, and since I was leading up to a post on dating and relationships, I felt the feminist movement was fitting. As a person who believes in equality for all, it disturbed me greatly to see a shift in that movement that seemed to border on hate. However, I wrote that post on December 11th.
With those two posts serving as scaffolding, it was time for me to use the “Red Pill,” “MGTOW,” “Sprinkle Sprinkle,” and other videos to write about relationships in 2025. Based on the videos, the dating scene seems to be in horrible shape. We are commoditizing people (both male and female) in a way that will doom society eventually. Is this really what is happening to dating? Are we all becoming objects to be used and thrown away when we are no longer shiny new pennies? Have we all become narcissistic creatures where others are simply there to be consumed?
I decided to conduct background statistical research on the topic, asking questions such as “Are marriage rates declining?” “What are the percentages of men between 18-29 who are not dating?” “What are the statistics on divorce rates?” “Who initiates most divorces?” … and so forth.
Although I usually write with a stream of conciseness (as I’m doing here) when I want to remember numbers (like stats), I’ll often save them in a file. Guess what? I already had a file on relationships I started in November of 2023! Apparently, I was going to write a post on this very same topic then, but chickened out, as I’m doing now… so I apologize.
Why am I holding off on writing this post? My November 2023 data predicted a horrific future for dating, commitment, and society as a whole. The data that I just gathered suggests that things have gotten worse.
For those seeking a serious relationship, it must be an extremely frustrating and arduous task. Tools, like dating apps, don’t help; they harm. Social Media doesn’t join and educate, it causes fear and dissension. It is very sad.
I try to post things that improve people’s lives, even something as simple as teaching someone to slow-cook a pot roast. When I post something controversial, I try to add some hope, or even a solution or two. Right now, I can’t do that when writing about the current state of dating and commitment. Therefore, I’m holding off on writing the post that I said I would. It is all very sad. I’m very sorry.
Julie has always been a feminist, and I have always believed that diversity is not only morally correct but also a benefit to society as a whole. My opinion goes beyond gender and includes the rights of all people, regardless of race, religion, or sexual orientation.
However, there is one thing that Julie does that bugs me; that is when she retorts that the woes in the world are due to our paternalistic society and the oppression of women by men. This post is meant to present a different perspective. You are invited to accept or reject my ideas. However, please don’t condemn them without giving them a moment’s thought.
My wife is a very bright person. She holds two Master’s Degrees and has two PhD degrees (Clinical Psychology and Social Psychology). She works professionally and has helped countless clients. She successfully runs her own business. She is economically stable and lives in a wonderful community. She has no real wants. I do not see her oppressed or limited in any way.
She could have accomplished all of these things on her own. However, my unwavering financial, emotional, and physical support made those impressive accomplishments easier for her to reach. I am her husband; that is the way it should be. I am also a man. Does my gender automatically make me an oppressor? To be fair, if you asked my wife this question, she would say I wasn’t. However, blanket statements about paternalistic, oppressive men drag me into that category by default. Imagine if the reverse were true, if I generalized the actions of an individual and turned them into blanket gender statements about women. “Women can’t think critically,” “Women can’t do math,” “Women are too emotional for leadership positions.” Are there women who fit these generalizations? Of course, but not all women. Those statements would be considered inappropriate, but male-bashing, even when done innocently, is considered OK in our society.
I don’t have a million-dollar grant to survey the population. My dataset is limited to my experiences and observations. Therefore, it is restricted. However, that limitation does not make my arguments invalid.
Am I a male outlier? What about other males? Does my son have a bias against women? Absolutely not. How about my male friends? No, they have all championed their wives ’ and daughters’ efforts. What about the males in my family? Here again, they have supported their wives and daughters to reach their life goals. My wife’s sister has two daughters and a son. Did their father (my brother-in-law) raise his daughters to be inferior to their son? The answer is no. These are different groups of men from various backgrounds, religions, and generations. All wanted the same for their spouses and children: to reach their goals and potential.
How about if I go back further in time to a much more conservative and constrained culture? What if I go back to my parents’ generation? My parents were born early in the 20th century and married in the 1930s. Both come from large, conservative, ethnic families. Both sets of grandparents immigrated to the US at the turn of the last century from conservative Eastern European countries. Both sides were deeply religious and closely tied to the Catholic Church.
On the surface, they should represent the most traditional values and ideals, and in some ways, they did. How did my parents, aunts, and uncles raise their children? Was there a gender gap?
Both my grandfathers worked in back-breaking, labor-intensive jobs. One fixed machines at a book bindery, the other was a machinist for International Harvester. I don’t believe that either job was particularly rewarding or fulfilling. My grandmothers were housewives, which was also an extremely taxing job. They did not live in a mechanized world; everything from doing laundry to making clothing was done manually. Both sides had large families, and my grandparents faced the mammoth task of raising many children. Money and labor were needed, which kept them very occupied.
All the older siblings in my mother’s family were boys, but the last three children, including my mother, were girls. I know little about her older siblings beyond a few scattered facts. I know that many of her siblings became very successful. A number of them were engineers; one founded a savings and loan; another owned a profitable manufacturing company. Pretty impressive considering that they came from nothing. I have childhood memories of being in awe when visiting their houses. I recall being in one huge house that had its own real library. What was in that library beyond books? An elevator to the upper floors! Wow.
I knew more about my dad’s side of the family. Here, there was a more traditional path to earning a living. Two of my uncles were electricians; two worked in factories; one owned a small furniture reupholstering business; and my dad was the chief operating engineer at one of Chicago’s largest high schools.
My dad’s story illustrates the era’s expectations, which were very different than today’s. He left school after 8th grade to help support my uncle (his brother), who was attending college to become a priest. I think such sacrifices were not that uncommon during that era, as you could still make a living with a limited education. How did he feel about cutting his education short? He often said he was glad to make the sacrifice; yet he attended night school for years, eventually winding up at the Armour Institute (now the Illinois Institute of Technology), so perhaps he did have a feeling or two. Editor’s note: My uncle eventually left the seminary and married. Fortunately for me, that union produced several of my cousins!
Both families were deeply ethnic and traditional, and they held high expectations for their children. Everyone went to church. Everyone was supposed to get married and have kids. Everyone was expected to marry someone with a similar ethnic and religious background. However, these expectations were the same for both sexes.
My mother worked in various jobs after she graduated from high school. There were no restrictions on her working. I’m not sure whether she worked after she married, but I do know there was a significant external push to have children. This pressure was on both my mother and father.
What about my generation? Were there different rules for my sisters and female cousins than for their male counterparts? I don’t believe so. We were all expected to live moral lives. There was an emphasis on showing respect to our elders. There were also religious rules; for instance, we couldn’t eat meat on Fridays. Those rules were the same for both boys and girls.
During my generation, there was a strong emphasis on education. I have two sisters, and both hold advanced degrees beyond their bachelor’s degrees. My one sister didn’t want to go to college, but my father encouraged her to go. He bargained with her to try it for at least a year. If she hated it, she was free to choose a different path. In the end, she earned a Bachelor’s degree, then a Master’s, and worked as both a teacher and a psychotherapist. There was no double standard in my family’s education.
How about my female cousins on my mom’s side? I have limited knowledge, but I know one sang with the Lyric Opera and the other taught. I know more about my female cousins on my dad’s side. Of those I know, all hold Bachelor’s degrees; in fact, I believe most have master’s degrees. Additionally, two hold PhDs and were university professors. Lastly, my male cousins’ wives held jobs, mostly in health care and the corporate world. There were no restrictions on what they could do or become.
As far as societal norms were concerned, women were expected to run the house, and men to provide and protect. Generally, that is what happened in my family. But there were also many exceptions.
In my conservative, religious extended family, societal restrictions on women were ignored. In fact, the opposite was happening. Women were being encouraged to succeed, to become educated, to move forward. I don’t believe my family was an outlier; I saw other’s doing the same things.
Have fringe religious groups used societal rules to control their members, including women? Yes. Have abusive, manipulative men used societal norms to control their wives? Yes. However, both genders can have members who are manipulative and abusive.
When I was growing up, we had a family in our neighborhood consisting of a couple and their only child. The husband worked as a bus driver to support the family, and the wife was a stay-at-home mom. She was dominant in every way. She and their daughter lived in the main part of the house, but her husband was required to live in their unfinished basement. In fact, his wife made him eat off separate dishes, with meals left for him on a tray next to the basement stairs.
How about societal norm outliers with my aunts and uncles? These were individuals who came of age in the 1930s and 1940s, so you would think that their roles were set in stone. On my dad’s side, my one uncle never married. He supported my grandmother financially, and she provided him with a home, meals, and the like. Per societal rules, he should have married. He wasn’t shunned in our family; he was celebrated and held in honor.
On my mother’s side, three of her siblings didn’t marry, including her only two sisters. My two aunts lived together in a functional partnership. They had defined roles, with my one aunt being more dominant and the decision-maker of the two. She attended DePaul University and was an accountant. My other aunt was an telephone operator who retired early due to health problems. She was the more domestic of the two. My unmarried uncle was a bit of a lost soul. He spent his work life testing radar equipment for Western Electric and led a solo life. His health was failing, likely contributed to by alcohol use, so my aunts took him in, and he joined their untraditional family.
That uncle was a kind person, but a bit of an odd duck. However, my aunts were esteemed in the family. There was no stigma around being single. In fact, the only time that I heard my father say a sexist thing about them was when, in the late 1950s, my aunt decided that she and my other aunt should buy a house. “How in the world are two women going to manage a house?” my father said to my mother. They did, and in fact, my one aunt became quite handy.
I also had several aunts who continued to work outside the home after marriage, one for Sears catalog and the other in an office job. I don’t recall hearing any negative comments about them working.
I had an uncle who didn’t work. He was an athletic guy who played minor league baseball in his youth. The line was that he had a heart attack in the1950s, and hadn’t worked since. Something never quite made much sense with that story, as I remember him looking pretty healthy in the 1970s. His wife owned a beauty shop, was the breadwinner, and the more dominant of the two. No one questioned their atypical marriage.
This was the reality that I witnessed. Society imposed rules and regulations on both men and women in my family. However, there were many exceptions to these rules. Parents made an effort to improve the lives of all their offspring, but those paths were shaped by the resources available at the time. For my parents’ generation, there was an emphasis on stable jobs and solid marriages with a strong religious center. For my generation, marriage was still important, but with role modifications. Women were encouraged to become more educated and to contribute financially. Men were encouraged to become more involved at home. These changes should have benefited all parties. In reality, it meant more work and more burnout for both the husband and wife. Not all housework is drudgery, and not all work-for-pay is rewarding. When the expectation is to do both, it can be taxing.
Why did gender roles occur in the first place? No one can say for sure, but it is improbable that they happened due to some plot of men to oppress women. Enduring behaviors continue for a reason and serve a purpose. Patriarchies have developed independently in many societies, but a few societies are matriarchal in their foundations. This suggests that either system can work, but it has generally been more productive for a group to pick one side or the other.
Most of us are familiar with the norm that the husband is the head of the family and the mother is the head of the household, but was it men or women who determined this concept of the typical monogamous nuclear family?
Some may say that men designed this to control their wives. We do see this in some groups, for instance, the fundamentalist LDS cults, where women are raised at an early age to be submissive and to “be sweet.” But there is more to that story. Fundamental LDS boys are often poorly educated to the point that many are illiterate. At an early age, they are sent to work on construction sites to raise money for the church. A few elders control the population, notably the group’s Prophet, whose word is considered the word of God. Powerful men may have many wives, and they can forbid less powerful men from having relationships with their own wives; they can even banish these men from the congregation and claim their wives, if they so desire. This is not men oppressing women; this is a small group of individuals, who are men, abusing their power to oppress an entire congregation for their own needs.
If we go back in time, it is clear that surviving was a tricky proposition. Humans are relatively weak animals, and they found that their chances improved when they lived in groups. In fact, there is evidence that Homo sapiens (us) have lived in groups since our species’s inception.
For a species to survive, it must reproduce. We are driven to exchange genetic material and produce offspring. This biological drive supersedes any constructs about the benefits of having children. However, I’m sure early humans also realized the advantage of a continuing supply of younger members to their community. Raising a child is a labor-intensive and energy-intensive undertaking, leaving the caregiver extremely vulnerable.
Males have a variety of options to spread their genetic material. One male can impregnate a multitude of females and leave them to fend for themselves. This “playing the numbers” method assumes that at least some offspring will survive. Another option is a male controlling many females. Here, the most successful/powerful males would pass on their genetic material while having some responsibility toward the females in their harem, usually providing some resources and protection. There are also matriarchal systems, such as the Minangkabau of Indonesia, that have developed their own mores and folkways for rearing children. Evolutionarily, some of the above options could be more efficient than monogamy at passing on the best genes to the next generation (contrary, also true). So what are the advantages of monogamy?
Men had the advantage of size and strength and were well-suited to hunting and protecting. Women were generally smaller and weaker. They also had the additional burden of caring for infants and children, which required years of intensive work. Women had a greater need to enter into a union for these reasons. Offspring had a better chance of survival when females were protected and provided for. What did they offer in return? Beyond intimacy, women could take on additional tasks beyond child-rearing. This made the relationship valuable for both parties. In reality, it was to women’s advantage to establish traditional roles. Is that why these unions happened? Who knows, but that seems more logical than men’s need to oppress women.
Throughout history, most men worked under exhausting conditions, often performing backbreaking jobs. Women’s roles were different because men and women are not the same. I’m NOT saying that men are more capable than women, I’m saying that men and women are different from each other. Women were also working very hard, but they were doing different tasks. This division of labor was logical and most efficient for thousands of years.
My grandfather worked long hours in a hot and dangerous factory. My grandmother had to manage a million different tasks from baking bread to plucking chickens. His work was likely tedious and mind-numbing. Her work was varied and more creative, but never-ending. However, together they were stronger, and by assuming different roles, they achieved a significant goal: survival and a better chance for their children to survive.
Life for the average person was very tough, with vast amounts of energy spent by both men and women on essential tasks. There was a small group of privileged men and women who, because of their position, followed a different set of rules. With enough money, one could bypass real life and hire maids, cooks, nannies, and any other necessary job-doer.
Things began to change in the early 20th century, most notably in the 1930s, when homes were increasingly electrified. Then, many labor-saving devices were introduced, from washing machines to refrigerators. Jobs that once required an entire day of intensive labor could now be completed in hours. Radio was becoming commonplace, and this medium brought information, culture, and new ideas into the typical home. This medium could bring product advertising to consumers on a daily, unrelenting basis. New, less physically taxing jobs were also growing. New medical treatments emerged, and the need to have large families to ensure offspring’s survival diminished. Convenience food products, like Bisquick, hit the grocer’s shelves. Now there was time to ponder life. Advertisers saw this time as an opportunity to build sales, which were sold along gender lines. Advertisements are designed to make you feel bad, then offer a solution, their product. Ads of beautiful, impossibly thin women made happy with a new vacuum cleaner, or handsome men in fashionable suits demonstrating their prowess by driving a new car, were commonplace. People had more time and were encouraged to buy more. Is it any surprise that gender roles started to change?
Life was changing, but not everything was moving forward at the same pace. This led to increased dissatisfaction and to movements ranging from women’s rights to worker unionization. This also pitted opposing forces who wanted the status quo. Why? Because those in power want to retain it, they will use their power to influence others. Those in power tried to convince the populace that unions would ruin the country. Those in power tried to convince the populace that granting women the right to vote (won in 1925) was unnecessary and would lead to chaos… and so forth. However, I hope Ihave shown that the average man wasn’t the enemy of women. That he saw his wife and female offspring positively. Gender roles and expectations may have looked rigid in a textbook, but they were far more flexible in real life.
So, where does the women’s movement fit into all of this? I was going to explore key figures such as Simone de Beauvoir, Sojourner Truth, and Gloria Steinem. But to be frank, my neck is starting to go stiff from sitting and typing, and I suspect I have already written so much that the vast majority of those who began to read this missive have since abandoned it.
Instead, I think I’ll write about a single pivotal figure, Betty Friedan, who wrote The Feminine Mystique and who co-founded the NOW movement.
Betty Friedan was an intellectually gifted, strong-willed woman. When her high school newspaper rejected her application to write a column, she started her own literary magazine. In 1938, she matriculated at Smith College, an elite institution and one of the “Seven Sisters,” women’s colleges. She excelled at Smith, graduating with high honors. After Smith, she had a one-year fellowship at Berkley studying under the famous psychologist Erik Erikson. At every level, Betty Friedan was exceptional.
She married Carl Friedan in 1947. Carl was a theater producer, inventor, and advertising executive. Betty worked as a writer and freelanced for magazines. Based on the above, it sounds like Betty had a good and elite life. However, she felt that something was missing.
In 1957, she went to her college’s 15-year reunion and surveyed her former classmates about their education, experiences, and satisfaction with their lives. This was a population of women who were likely financially privileged. It should be noted that in 1940 (when these women were attending college), only 5.5% of men and 3.8% of women graduated, and Smith was not an ordinary college; it was an elite institution. I imagine that these women married successful men, who, by their very nature, worked a lot. It is also likely that their economic and social status afforded them more free time than the average housewife. Here was a situation of intelligent, educated women living routine, isolated lives. Is there any wonder that they were unhappy? In fact, Friedan talks about the “terror of being alone” in her groundbreaking 1963 book, The Feminine Mystique.” The book that launched the second feminist wave.
Friedan believed that women should be able to pursue meaningful work commensurate with their intellectual capacity. I don’t think anyone could argue with this. However, in an NBC interview, she made it clear that she disagreed with radical elements of the feminist movement that saw men as the enemy. She felt that men and women should work together to liberate both from obsolete sex roles. That is very different from the current stance of men vs women. The reality is that the typical man has been locked and bound in roles just as females have been. It is just that these roles have traditionally been different, as I discussed above. So why has it become so easy to blanket men in general, when most men suffered the same fate as most women? We may have had different expectations placed on us, but that doesn’t mean that we were less free. Did we have more choices? In the past, it was easier for a man to become a scientist or engineer, but those roles were reserved for a select few. Most men were stuck doing grunt work, often under cruel bosses, in horrible conditions, and with little praise. It was expected that men would earn money and support their families. Men who chose specific careers that were deemed too feminine were mocked and ridiculed. The reality was that old rules trapped both men and women, and these rules were changing more slowly than other societal changes. The most effective path would have been for men and women to join together, but that didn’t happen. Why? Likely because most of us want to have our cake and eat it too. Did women want to give up the good aspects of being a woman (yes, there were good aspects)? No, they wanted to keep them but gain new opportunities. The same could be said of men who wanted more freedom in their roles but feared they would lose their primary function: to provide and protect.
Additionally, it is always easier to find an enemy to blame, and the easier it is to identify the enemy, the better. “I’m not happy and satisfied because of men!” “I’m not happy and satisfied because of women!” In some ways, this mobilizes a cause, but it eventually becomes destructive, which I hope to illustrate in my next post.
But who is to blame for these rigid roles? In part, it is life. For most of the last thousand years, our goal was just to survive. People didn’t think about self-actualization; they thought about where they were going to find the next potato. Once roles are established, they become challenging to change.
Additionally, people in power want to stay in control, and they view any “other” as a threat to that power. Was the typical man in power? No, we were not. Most in power were indeed men, but most men were not part of this powerful minority. We accepted our roles, our fate, and carried out our jobs, even when we didn’t want to, just like women did. Did this one-size-fits-all work any better for men? Nope, but it was what it was. Yes, there have always been abusive husbands, but there have also been abusive wives. There have been religious groups that used their power to manipulate girls, but they also manipulated boys. At the same time, there have always been those who charted their own course, and I’m not talking about heroes like Emelia Eirhart or Madame Curie. Just in my very average family, some individuals bucked the norms because it suited their needs.
Our country has become progressively polarized into absolutes. Good vs. evil, men vs. women, Christian vs. Muslim, and so it goes. When it becomes easy to cast blame on someone else, it becomes challenging to make meaningful change. Why change when you are right, and the other person (or group) is wrong? They should change, not you! Such a stance not only strips the accuser of power but also alienates the accused, leading to stagnation rather than progress. That divisiveness may be what those in power want.
When both husband and wife were working to their limits to survive, there wasn’t much time for either to assess whether they were living fulfilling lives. The traditional husband-and-wife system worked, but it worked better for some than for others.
I stated at the beginning of this post that our society is better when we fully embrace all forms of diversity. This means we must find common ground, not common enemies. Some of us want to be astronauts, and others are content to sweep floors. Some women are happy in traditional housewife roles, while others seek to discover the cure for cancer. Some of us are happy despite our circumstances, and others who can bleed sadness from even the most joyful experience. We are all different, and we all have the right to live to our desires and potential. The problem we should solve is how men and women can work together. We need to let go of generalized statements designed to inflict harm on either sex. Societies chose paternalistic or maternalistic models for a reason; they served a purpose. They are not inherently evil, and we would not have the lives that we do if those models were not in place. Yes, rules need to change, but to blame all the woes of women on men is not only inaccurate, but it is also cruel.
We need to move past blaming entire groups. Just think about how much recent damage we have done to our society by castigating Muslims, Hispanics, Somali, Gays, and Trans people. What benefits were gained from these actions? None. What harm was done? Quite a bit, not only to those groups, but to our society as a whole.
However, it serves only the rich and powerful. By assigning blame, the country can focus on those groups rather than on other policies that will affect everyone in the future.
Betty Friedan identified a problem affecting her social group: wealthy, educated women. However, it shed light on a broader issue: rigid roles for both men and women. Somehow, that truth has been converted to men are bad, women are victims, while at the same time dictating a new rigidity for women, as witnessed by the backlash against Trad Wives, those women who embrace traditional values.
There will be individuals who use whatever they can to control and dominate others. However, that is not the case for most. A bigger problem is those in our society with ultimate power. The individuals who set the tone for the rest of us to follow. Instead of talking about toxic masculinity, it may make more sense to look at the power brokers who make it difficult for people to live lives. If you don’t believe this, just go to any social media platform, which is now the most powerful source of influence. With little effort, you will find countless influencers who will tell both men and women that the other side is wrong. That will be the topic of my next post. But for now, please stop using blanket statements that incriminate entire genders. It is wrong and hurtful. If you call someone an enemy for long enough, they will become what you conjure. Is that what we want?
When I watch one video on YouTube, I’m instantly presented with similar videos on my “For You” page. Facebook shows 6-7 posts from random sources it thinks I would be interested in before presenting any content from my actual Facebook friends. When I turn on the radio, it is easy to find stations that have one-sided political beliefs. If I were dating, I could load up apps to cherry-pick potential dating partners. Social media is full of unqualified, self-promoting influencers who gladly tell me what to eat, what to believe, and what to wear. My content is being curated, and information is presented to me on a silver platter. That’s good, right? I would say no. In fact, I believe this is one of the most destructive trends to have ever impacted individuals and society as a whole.
I clicked on a “short” video on YouTube titled “All men should know this about women.” This led me down a rabbit hole of more and more videos from the manosphere. A segment of content that typically shows videos of disrespectful women stating things like, “If a man won’t send me an Uber, pay for my babysitter, my hair and nails, and take me out to an expensive restaurant, he is not worth a first date!” The male commentators typically highlight these ridiculous expectations, noting how women see men as a meal ticket and nothing more.
There are an equal number of channels for women who examine how men treat them as sex objects or just want a mama to take care of them. These channels present men in a similarly disgusting and predatory way.
I have always been a fan of radio. In fact, radio changed my life when, as a kid. I fixed an old shortwave radio that I found in our basement. This allowed me to listen to English-language broadcasts from countries with vastly different views from the United States. It was incredibly educational for me to hear their logical opinions, which were sometimes the opposite of what I was hearing statewide; it started me on a path to become a critical thinker.
Occasionally, I will do an AM radio band scan, starting at 520 kHz and working my way down to 1710 kHz, while listening to content. AM radio has gone from a medium encompassing a wide range of interests to a narrow zone of mediocrity. Sports, some news, religious, and foreign-language stations are available, but the predominant focus seems to be political. This has been especially true when I have traveled to more rural areas of the US, locations that may be served by only one or two radio stations. Here, the majority of stations are very politically right, and they often carry the same syndicated programming. These stations are hateful with a common theme: the right is always right, and the left is always evil, corrupt, communist, or whatever.
What about cable news channels? If you want to hear that the left is always right, watch CNN or MSNBC. If you want to hear that the right is always right, click on Fox News. It is possible to find similar biases across just about any social media platform, including YouTube and Facebook. Both of these venues have figured out that I lean left, and they are happy to serve up tons of that type of content, with zero right-leaning information. I never see an opposing viewpoint.
I’m not in the dating pool, but my kids have told me that most dating is now done on apps, where you can swipe left to reject someone or swipe right if you are interested. This creates so many problems for both sexes, as women are presented with hundreds of choices, and naturally, they are going to cherry-pick the most exciting ones. Why is that a problem? Because many are choosing the same 10% of top-tier men, and rejecting the rest. Competing with such a large pool reduces an individual’s chances of success. Additionally, this selection process is done based on a few characteristics, like looks, and ignores other qualities that are more likely to indicate a quality relationship.
I remember treating a very nice patient who was suffering from rare panic attacks. This person was genuinely a good guy. He was a newly minted lawyer working in the legal field, but he was having trouble finding a decent firm that would take him on. He was good-looking, polite, stable, loyal, and had good values. He wanted a serious girlfriend and eventually wanted to be married with kids, but no one would click on him because he was on the shorter side, and (per him) women want 666 men: 6 feet tall, 6-figure income, 6-pack abs. Social media told women that 666 was the minimum requirement.
How many posts on social media have I seen where some pseudo-expert claims that we are killing ourselves because we are using peanut oil, or that we can avoid dementia by taking the special supplement that they are selling? You must believe!
Why is this curation happening? Is it to help us? No, it is to encourage continued engagement. The more outrageous and one-sided the content is, the more likely it is to command the viewer’s attention. The old newspaper line, “If it bleeds, it leads,” was true then and truer now. The more engaged and enraged a person is, the more they can be manipulated. This is especially true when an idea is cleverly paired with another one, often by misrepresenting information and sometimes by outright lies.
Combine universal healthcare with Communism. How about pitting public health policies against individual rights? Another common ploy is to pit religion against science. Although these examples may sound ridiculous, they have all been successfully used to shape opinion and to control others.
Social media can also suppress opposing information. Suppose I have the belief that pasteurizing milk was not implemented to prevent raw milk illnesses, like listeria, but was done by some evil science cabal that wants to control me. Social media allows me to find cult leaders and individuals with similar ideology easily. The more cult-like a group is, the more likely it is to demand social isolation and obedience. Such beliefs may be funny to others when the individual is convinced that the earth is flat, but less humorous when parents place their children and their community in harm’s way by rejecting proven vaccinations.
Confirmation bias is a psychological tendency to accept information that supports one’s beliefs while rejecting information that contradicts those beliefs. We all tend to have some confirmational bias. However, when severe, that bias prevents us from making good decisions and hampers our ability to think critically. In the past, we would hear opposing opinions from those around us. We then had to sort out the information by examining all of the variables. Media sources were required to present information as objectively as possible. This was especially true of radio and television, which used public airwaves. You could read the “National Enquirer” for gossip, but you knew that your local newspaper would give you the facts. Many news organizations had local news reporters and investigative units, groups that have now often been dismantled for various reasons. As reporting has become more centralized, it allows for more corruption and misinformation.
It is imperative that we, as citizens, regain our critical thinking skills and stop accepting biased information from self-serving individuals and groups. But how can we do this? The first step is to recognize the problem. If you are reading or watching content that consistently upsets or angers you, there is a chance you are being manipulated. If you belong to a group or organization, including a religious one, that demands that you think in a certain way and where questioning is considered disloyalty, you are being manipulated. If you can not have a rational conversation with someone with an opposing view, you have already been manipulated.
What can be done?
-Avoid curated content that biases you against any other group. I’m not saying that you shouldn’t stay informed or have an opinion; I’m saying that you should avoid editorial content on YouTube, cable news, and other sources. The vast amount of information on cable news is editorial, and therefore often biased. Much is designed to be rage bait, keeping you watching. Expose yourself to “the other side.” If all you watch is Fox News, dip into CNN now and then. Better yet, avoid both and go for a more neutral news source, like over-the-air news, which has to conform to anti-bias rules. An additional option is to pick unbiased sources like the BBC, which is now easy to access online. I tend to listen to US-based news summaries and supplement them with other balanced sources.
-Avoid all hateful channels on places like YouTube. The world is a better place when we work together, as we have for millennia. When it comes to dating apps, women are in control. Here I may sound like an old codger… but I guess that is what I am. Women, look past the superficial and focus on the qualities that really determine a good mate. Here is another true story. When I was in med school, I knew a woman who was trying to find a boyfriend (I was married at the time). I had a friend in med school who I thought would be a great catch. He was very average-looking, but a great guy. He was smart, kind, considerate, and thoughtful. He was motivated to succeed and (in fact) obtained a pharmacy degree prior to getting into med school. He had great earning potential. He wanted to settle down and was looking for a serious relationship. He had the potential to become a great dad. I arranged a blind date, and he took my friend to a very nice restaurant for dinner. I was shocked when she summarily rejected him as he gave her the “ick.” Why? Because he brought her flowers on their first date, and that was “too much.” Holy cow. I’m happy to report that he is now happily married to someone who saw him as he actually was. His wife scored a good one.
-Broaden your mind. Although I’m more liberal-leaning, I’m always willing to listen to opposing views in a civil conversation. Sometimes I change my views, most times I don’t. However, I leave knowing why a person thinks as they do, and by doing so, I know that they are not my enemy. It is OK to have a different point of view.
-Use your critical thinking skills. If an individual or group demands that you think uncritically, allow yourself to question their motivations. There are so many examples of this, from claiming that everything is “fake news” to impostor influencers peddling their lotions and potions, to “experts” with statements like “This food will cure cancer!” Our current best way of determining something is by studying real data and testing outcomes. Listen to the majority expert opinion, not some quack. Majority opinions are sometimes wrong, but quack views are often wrong and self-serving.
We all benefit when we understand and accept each other and work together. Those who want to split us based on hate rhetoric have their reasons, and those reasons do not benefit us; they only help them.
Over the years, I have observed a phenomenon in various situations: I have dubbed it the Distance Rule. The rule is simple: the greater you can separate yourself from a person or group, the easier it is to justify or ignore harmful actions against that person or group.
The converse rule, which I call the Closeness Rule, also applies. The more one can relate to a person or group, the more difficult it is to justify harmful actions against that person or group.
There is a qualifier. These rules apply to individuals who have a moral center. Those with sociopathic tendencies will do whatever is in their best interest, as their ability to empathize with another person is absent.
Lastly, there is the phenomenon that I call Convenient Sociopathy, where it is so advantageous for an individual or organization to dehumanize an individual or group that they find a rationale to do so, often using the Distance Rule. Think of the corporation Enron, which regularly turned off electric power to parts of California, which caused harm to the most vulnerable while increasing the wealth of Enron’s shareholders.
Entire nations can use these rules, often employing propaganda to reach a goal. This tactic is always seen in war situations. During WWII, American propaganda portrayed both the Japanese and German citizens as bloodthirsty monsters, making it easier for US soldiers and the homefront to unite against them. Naturally, similar campaigns were launched against Americans in those countries.
Additionally, a systematic propaganda campaign was developed against non-Arians in Germany in the 1930s, and specific efforts by Germany, Italy, and Spain were developed to eliminate a particular minority population, the Jews.
Other groups were also targeted, from Eastern Europeans, to Romani, to gays, to those with physical, mental, and psychological issues. Creating an emotional distance between these groups and the general population allowed ordinary citizens to do the most horrific things to human beings.
It is easy to devise a method to separate one group from another. However, this process is more effective if the aggressor uses an easy-to-identify characteristic such as race, religion, economic status, education level, sexual orientation, or nationality. The aggressor’s goal is to gain power and control. That power can be expressed in privilege, wealth, or other forms of domination.
A common characteristic of serial killers is that they dehumanize their victims, using the Distance Rule to turn them into objects for gratification. This can be seen in predators who kill for sexual thrills, such as John Wayne Gacy and the BTK killer Dennis Rader.
The ability to distance from others to justify a behavior can be seen in less global ways. As a psychotherapist, I would see patients use the Distance Rule to create an emotional separation from a spouse when they enter into an affair relationship. At the same time, I would witness them using the Closeness Rule to idealize the affair partner as further justification for their actions. I have never heard a person active in an affair say something like, “My spouse is great, but I decided to cheat on them anyway.” Typically, an excuse is made focusing on their spouse’s flaws, lack of sexual response, inattentiveness, or whatever. Likewise, the AP is usually characterized in an ideal way as the one “who understands me,” the one “I can talk to,” or the one “who appreciates my sexual prowess.”
This Distance Rule is commonly seen in the corporate world and was promulgated by Jack Welch, the former CEO of General Electric. Before Mr. Welch, most large corporations’ strategies were for long-term, steady growth. Giving a workforce a sense of stability and rewarding them for their loyalty was part of that growth equation. Jack’s focus was very different. He saw a corporation as a profit-generating machine for stockholders and felt that the role of a corporation was to benefit those individuals. So be it if a job could be done less expensively in another country. A division that was not as profitable as another one should be closed and damn to the factory workers and communities that they lived in. Using that method, Jack made a lot of money for GE’s shareholders and himself.
GE survived as a corporation. However, this Distancing Rule sometimes destroys not only lives but also corporations. One example of that phenomenon is former Sunbeam CEO Albert Dunlap, known as Chainsaw Al for his business practices.
Sunbeam Corporation was a 100-year-old company that made small appliances under the Sunbeam and Oster brands. These were well-regarded US-made appliances. My mother used a Sunbeam Mixer daily from the 1950s until the 1970s, when she was gifted a Kitchenade Mixer. That original Sunbeam Mixmaster was a quality product. However, due to mismanagement, Sunbeam was less profitable than possible, so they brought in Chainsaw Al to improve the bottom line. Al fired around 50% of Sunbeam employees, closed down most of Sunbeam’s factories, and reduced their product line, destroying the lives of many. Robert Reich, then secretary of labor, noted, “There is no excuse for treating employees as if they are disposable pieces of equipment,” Chainsaw Al promoted stock options, which meant that any profit for Sunbeam shareholders would also benefit him. He was incentivized to do whatever it took to inflate Sunbeam’s stock, and that is precisely what he did, using fraudulent and illegal tactics that resulted in Sunbeam filing bankruptcy in 2001. Al left the corporate world with millions in his pockets despite paying off federal fines and penalties for his illegal practices. His fines were a small price to pay. Sunbeam was sold several times to larger entities, and Newell Brands now owns it. You can still find Sunbeam-branded products, including a crap version of the Mixmaster, which is now manufactured in China. No one aspires to have a new Mixmaster as the once legendary product has fallen far from grace.
The top 1% of income earners are those so isolated from the general population that the populace can become an object to achieve further gain rather than human beings with lives, families, and aspirations.
I know of a university student who was given an internship at Amazon. She was treated well in that temporary position, but she was appalled that workers were treated like machines. For instance, lower-level workers were written up if they ever sat down. Can you imagine?
Educated professionals can also be treated like commodities. For decades, we have been told that the secret to success was to become educated. Universities grew and prospered as US tuition reached stratospheric proportions. Students studied complex STEM disciplines like engineering and computer science with the promise of a secure and financially stable life. Currently, many of these individuals can’t find jobs or have been laid off as they try to cope with massive student debt, excessive mortgages, and rising inflation.
A particularly heinous practice in the US has been incentivizing shareholder profits in health care. Let me first say this clearly: there is no justification to murder another person. However, I can understand the anger and rage placed on corporations that enrich themselves by acting as the unnecessary middleman in an industry that is supposed to help people and not cause harm.
We have been sold a bill of goods that says our health system is the best in the world; it is not. Did you know that citizens in 48 other countries, including Costa Rica and Albania, have greater longevity than in the US? Did you know that many citizens in countries with universal health care are happy with it and can’t imagine the healthcare shenanigans that happen in the US? Did you know that medical debt is the number one reason for bankruptcy in the US? Did you know all developed countries except the US have healthcare for all? It is accepted as a benefit of an enlightened society, just like free education, fire departments, and public libraries. No one says, “I don’t want my kids to learn how to read and write because it will turn our country into a socialist state!”
Many attempts have been made to establish universal health care in the US starting in the 1800s, including efforts from Presidents Theodore Roosevelt, Franklin Delano Roosevelt, and Harry Truman. Are you aware that beyond profit interests, one reason for this not happening was racism? Efforts for universal healthcare in the US started after the Civil War, but they were shot down by politicians, mainly from the South, as universal healthcare would have to include blacks. White legislators noted, “Free assistance of any kind would breed dependence, and when that came to black infirmity (Ed note: sickness), hard labor is a better salve than white medicine.” This should not be shocking as blacks have been excluded from many social reforms. Large numbers of blacks were excluded from the 1935 Social Security Act, and structural discrimination limited black’s access to the GI Bill.
Private health insurance became a popular perk used by companies to entice workers during WWII when wages were frozen. This perk became a factor in amplifying the health insurance industry.
Somehow, PR has made us believe that healthcare isn’t a right but a privilege. To that end, 27 million US citizens are uninsured despite programs like Medicaid and the Affordable Health Care Act. This impacts all of us and our economy and is often the case due to governmental barriers at the state level.
Traditional Medicare is a government-run healthcare program that its users generally like. Its administrative costs are 10 times less than private health insurance programs like Medicare Advantage. Traditional Medicare has a near-zero denial rate for accepted procedures. Lastly, its network of hospitals and doctors is vastly more expansive than any Medicare Advantage program. Medicare Advantage subscribers often give up traditional Medicare and sign up with a private insurance company because they are promised trivial perks. Getting free stuff sounds terrific until you have a significant and expensive need and your Advantage program denies or delays approval.
Regular private health insurance also practices these tactics. A loved one of mine had a spinal fusion, and we were told that she would be in the hospital for 4-5 days due to the complexity of the procedure. After 24 hours, the insurance company was pushing for discharge, and despite my efforts, my loved one was discharged at 36 hours. My loved one wasn’t making sense, could barely stand, and was in terrific pain. We had to provide complete nursing care at home for many days. Thankfully, I’m retired and have the knowledge and family support to take on that role. How many others don’t have those resources?
Medicare Advantage programs are under government investigation for fraudulent billing practices and denial of claims. It has been proven that Medicare Advantage offers a lower quality of care while costing the government more than traditional Medicare. So why are seniors always being pushed to go with an Advantage program? Well, there is a reason that insurance companies spent over $117,000,00.00 in campaign contributions and lobbying efforts in 2024. We already have government health insurance in conventional Medicare, and it works quite well, but it doesn’t make a profit for shareholders and CEOs.
By using the Distance Rule, insurance clients become objects to be manipulated to increase profits for shareholders and employees of the company. The recent tragedy of the murder of the CEO of United Health Care brought to the forefront the level of corruption in the industry. Yes, that CEO was being investigated for insider trading. Yes, he made 10 million dollars in his last year’s salary. Yes, he illegally sold 15 million dollars of UHC stocks when he knew the stock was about to tank due to an FTC investigation. That is horrible, but nothing compared to a 32% denial of claims by UHC. That means almost one-third of requests from mammograms to life-saving surgeries were denied. Those denials were made by a computer program, not a medical expert, and that software is reported to be wrong 90% of the time! Consider the consequences and damage to our society by turning human beings into objects that can be manipulated to gain corporate profit.
You may think insurance company denials are based on preventing evil doctors from performing unnecessary procedures, but that is not true. Some of the most significant legal investigations involving health care are due to insurance companies’ fraudulent billing of Medicare/Medicaid. Additionally, many doctors have stories of insurance companies denying payment even after getting pre-approved for a procedure. When insurance companies do pay, they can delay payment for months, causing hardship for practices with large overheads . Many rural and less endowed hospitals have been forced to close because of these and other practices, leaving entire communities without health care.
Insurance companies know that only about 0.2% of denials are ever appealed. Clients may not know that they have that right to appeal or may not have the psychological energy to launch such a process during their health crisis. Recently, our family had to face an insurance denial. A loved one was diagnosed with a rare and life-threatening condition that was so complicated that it required traveling to a university hospital. A very long, complex, and potentially dangerous operation needed to be performed, and the university hospital got pre-approval for the procedure from the insurance company. The operation took over 7.5 hours and involved a team of the hospital’s top doctors, including department chairs. Yet, 6 months after the operation, we received a bill for thousands of dollars as the insurance company denied a PART of the operation. I’m a physician; how do you deny PART of a pre-approved operation for a life-threatening condition? That makes little sense. I did appeal the decision and was rejected twice by the insurance company. I eventually filed a complaint with my state’s insurance commission before the charges were reversed. If only 0.2% appeal an insurance denial, how many of those 0.2% also know you can file a complaint to a regulatory commission? Likely, not many. Bonus for the insurance company.
In our modern society, individuals are becoming more isolated from each other. People work from home, friends connect via text messages, and groups isolate themselves due to their ever-widening economic status. All of this makes it easier to apply the Distance Rule.
I live in an affluent community. I see entire families dining at expensive restaurants on weekdays. It is a place where people walk down pristine walking paths sporting designer clothes. A place where many belong to a gym because they rarely do productive physical exercise. It is a wonderful place to live, and I’m very grateful that I am fortunate to have called my town my home. However, a short drive in almost any direction can take me to a different place. A place where poverty is evident. Where grocery stores don’t exist. Where schools are places of violence. A place where poverty drives crime, addiction, and fear. I generally avoid those places, as most of my neighbors do. We don’t have to think about the plight of those human beings; they are far away, making it easy to objectify them. Objects that we can blame and then ignore. “That’s not my problem. Look at how successful I am,” we say—ignoring the opportunities that we have had. That is how things work in our society. If it doesn’t directly impact the individual, it is ignored. However, as we continue to distance ourselves from others on all levels, the result is that we will also eventually suffer.
I was raised in a working-class neighborhood but managed to attend one of the country’s best medical schools. Everyone who works hard enough can do the same, right? Wrong. I had many advantages in my favor. I lived in a stable home and never worried that we would be evicted. There was always food on the table. Both sides of my family are academically oriented. My parents strongly emphasized the importance of education. I didn’t have the advantages of some, but I had many more benefits than many. This enabled me to use my only gift, my ability to think, to my advantage. Would that be the case if I was always hungry or afraid to go to school because I could be shot? I don’t think so.
Yet, it is still easy for me to objectify others using the Distance Rule. I have to actively put myself in the shoes of others. I have conservative friends and family, and I make an effort to understand their positions. I have working-class friends whose reality differs from mine, and I try to put myself in their shoes. When I drive through a poor neighborhood, I try to comprehend those people’s obstacles. When dealing with a persecuted minority, I imagine what their life must be like on a day-to-day basis.
Recently, I have had someone I know come out as trans. She possesses the courage and resolve that few, including myself, have. However, as a minority, she will suffer from the Distance Rule. In my professional life, I have worked with trans people. They represent an extremely tiny percentage of the population. Their wish is simple; they want to have freedom to live their life and to be left alone. There is NO evidence that they want to convert others to their position or that they get off from entering a bathroom. They just don’t want to be persecuted. Yet, look at how easy it has been to use the Distance Rule to objectify them and make them into an object of hate. Why do this? If you want to control a group, find another vulnerable group they can fear and hate and then promise to protect the majority group from that imaginary threat. A method as old as time.
We live in a society where the distance between different groups grows daily. That distance may be measured in terms of physical distance, monetary distance, educational distance, belief distance, racial distance, sexual orientation distance, liberal vs conservative distance, and just about any other separation you can think of. Consider this quote from our Pledge of Allegiance, “One nation, indivisible, with liberty and justice for all.” Think of the power and wisdom of that statement. When we apply the Distance Rule, we negate this promise. In the short term, it makes our lives easier. In the short term, it allows others to manipulate us and makes some richer. But what about the long term? What about our country and its promise to treat all fairly? In a country that should be the greatest on earth, such separations make the rich richer and the poor poorer. This can only lead to eventual collapse and disaster. That is common sense. Did you know that the three wealthiest individuals in the US have more money than the lowest 50 percent of the population? Three individuals have more wealth than the combined worth of 167 million humans. Their distance from that population is unfathomable.
Government and industry leaders have employed the Distance Rule to split populations so they could manipulate them and extract power and wealth from them. Why do we buy such a ridiculous concept that hurts everyone except for a few at the top?
If you accept even ten percent of the premise of this post, it is incumbent on you to move from passive acceptance of the status quo to active pursuit of a better way. You need to reject the Distance Rule and embrace the Closeness Rule. You need to look at how we are all more similar than different. At the same time, it is imperative to accept those slight differences that we do have and not buy into the manipulation of others who use minor differences as weapons to separate us.
Find common similarities between you and someone different from you. Listen to their dreams and their life struggles. You don’t have to adopt their ideas; they don’t have to convert to yours. It is OK to be different. At the same time, open your mind, as you may find that some of your beliefs may change as you understand who they are as human beings. In turn, they may do likewise. Focus on the humanity of others. Immanuel Kant developed the Categorical Imperative in the late 1700s. The Golden Rule is as old as time. We know what we need to do, but we are manipulated to do otherwise.
A talking point from this last election was, “Are you better off than you were 4 years ago?” It was a powerful point and likely won the presidency. However, it was a manipulation because the statement should have been, “Are you better off than you were 40 years ago.” For most, the answer would have been “No.” But that reason is not because of the immigrants, or blacks, or trans people, or whatever. It is because wealth has steadily moved from the poor to the rich. That is the reality that the 1% doesn’t want you to know. They effectively used the DistanceRule to deflect blame onto vulnerable groups that can’t defend themselves. Remember, we are always stronger when we work together. We are weaker when we allow others to separate us into groups, as that weakness can be exploited to all our detriment.
When I told my father my plans he was clearly displeased. It was a spring day, and I was talking to him in his south suburban backyard. “Dad, I’m going to specialize in psychiatry.” His response was quick and sharp, “Why would you want to do that? You should become a real doctor. Psychiatrists aren’t doctors.”
By that point in my life, I had long charted my own course. I listened respectfully, but internally, I ignored his commands. I no longer needed his approval, and my conversation was more perfunctory rather than advice-seeking. He had his agenda, and I had mine. Since my decision would directly impact me, it was my decision to make. I subtly changed the topic to something that I knew would interest him. It was a deliberate manipulation on my part to a neutral subject, and the conversation moved forward.
His question was valid for other reasons. Why had I decided on this career path? My answer was both surprising yet understandable.
There are certain key events in my life that I write about repeatedly. They serve as markers that indicate significant changes in my knowledge of myself and the world around me. They are the road signs to my life. Many other factors are equally important, but these events note a change in understanding or direction. A fork in the road that led to a different journey.
I often talk about my dyslexia, a diagnosis that is only partially accurate. I use the term because it is relatable. In reality, I have a variety of processing differences that can make simple tasks difficult for me. For instance, I can visualize abstract concepts but can’t assemble a simple children’s jigsaw puzzle. This processing disparity was evident when I was in second grade and couldn’t read. In the early 1960s, the concept of learning disabilities was utterly foreign at the Catholic grade school that I attended. My teacher, a nun, recognized that I was smart and erroneously concluded that my inability was caused by a vision problem, which prompted my parents to get me a pair of glasses. This was a significant expense, and my father was not pleased, but he complied.
I was hoping for a miracle and was crushed to discover that they did little to translate the incomprehensible set of symbols that moved around the page with a mind of their own. I was at a phase in my life when I thought that any imperfection in me reflected poorly on my family and parents, and I was terrified of gaining even more displeasure from my father.
Yet, I had a certain confidence in myself, likely boosted by my teachers, who would comment on how smart I was. I had to devise a solution, and I felt confident I could. But what resources did I have? How could I take something I already had and use it as a tool? The answer came to me via the Sunday comics. There was a strip called “Nancy” that was very simple in both its storyline and vocabulary. I could piece together the words by tying them to the pictures. The traditional way I was being taught to read would never work for me because I could not see the separation between words and lines of text. However, if I viewed a word as a shape instead of a series of letters, I could decipher its meaning. My brain could do that, and print started to make sense. I did many other things to teach my brain how to read. Soon, an entire world of information was revealed to me. By the time I took my 4th-grade achievement tests, I was testing at the 11th-grade level.
I was a big kid, so I can’t say that I was the object of a lot of bullying. I was part of the mass group of kids; neither a member of the popular crowd nor the reject group. I had friends, and I did things. Yet, I felt like an imposter. Subjects that interested my friends didn’t particularly interest me, and things that I was interested in held no interest with them. I learned that to be accepted, I would have to show interest in what interested them while hiding those things that I was interested in.
My salvation was science, and my teachers were the pseudo-scientists of the B science fiction movies that I would watch on late-night TV. My ultimate hero and male role model was Don Herbert, AKA “Mr. Wizard” of TV fame. Mr. Wizard seemed to have the answer to how everything and anything worked. He showed me that there was a method to understanding, a way to prove ideas, and a methodology to learning. What he demonstrated formally was consistent with what I had been doing organically. Mr. Wizard didn’t know me, but he understood me. He had to, as what he was explaining on TV was exactly how I was already solving problems. Mr. Wizard allowed me to feel “normal.” I no longer believed I had to fake who I was; at least one person understood me.
My success in learning how to read taught me that authorities didn’t always know what was best and that there were solutions to seemingly impossible problems if I allowed myself to think outside the box. Mr. Wizard gave me a formal set of rules to test ideas. Science and math provided the tools to implement those solutions. I was suddenly empowered.
It was only natural that I would pursue science, and as I have said in a previous post, the most logical course of action would have been to obtain a Ph.D. and pursue a university career. I’m a rational person who examines potential outcomes, plots a course to achieve a particular goal, and then pursues that goal with force and dedication. It works… well, sort of… well, sometimes…well, hmmm..ummm…keep reading.
I have already told you how I successfully reached my goal of graduate school and even had the school pay for my education. A perfect plan? Then, despite all logic to the contrary, I had an irresistible urge to abandon my plan and apply to medical school, which was an insane idea that was bound to fail. I knew that I would never be accepted into medical school. All of my logic, all of my “scientific method,” and all of my dreams were tossed aside for a whim. Yet, that was precisely what I did; I allowed a force outside of myself to control my actions. I was as shocked as anyone when multiple medical schools accepted me. Many of them referred to how meaningful my personal statement was to them. Here was a kid who couldn’t read in second grade who was now moving doctors with his writing. Life is strange, isn’t it?
I have always had an immense interest in the interface between chemistry and biology. My graduate work centered on changes to proteins as they are extruded through a bacteria’s cell membrane. During my application to med school year, I left grad school and got a research job at the University of Chicago using tissue culture models to study Multiple Sclerosis. We were using a cutting-edge technology (this was in the 1970s) called monoclonal antibodies to create specific markers. Even then, I could see how such a targeted method could be utilized clinically, from cancer treatment to fighting infections. However, those advancements would be decades in the future.
Logic would dictate that I pursue an area of medicine that incorporated my scientific knowledge with clinical practice. The options were plenty: internal medicine sub-specialties like infectious diseases and endocrinology to specialties like Neurology. I knew that one of those areas would be a perfect fit. However, they weren’t.
I was so excited to do my internal medicine rotations, but they disappointed me. I spent 90% of my time running down labs, examining scans, and writing notes. The time that I spent with patients was minimal. It felt like I was back in the lab, but my subjects were humans this time. As a family practice doctor, I may have been happy as that medicine was more integrative. However, family practice options were discouraged at Northwestern. When I asked the medical school dean why, he responded, “Our mission is to produce specialists.” Despite this, my problem-solving and goal-direction abilities pointed me toward an internal medicine subspecialty. It was where my background and interests led me.
Psychiatry was never a consideration. I had some fears about the profession. My mother was frequently hospitalized for ketoacidosis, a condition caused by her out-of-control diabetes. Once, she was in a medical unit that shared a floor with Christ Hospital’s psych unit. That unit had an imposing locked metal door with a thin slit window made more solid with embedded mesh wire. It was scary looking, but young me was curious. I crept up to the door and, with all the courage I could muster, looked into the window, not knowing what to expect. From out of nowhere, a face appeared directly opposite me. A deranged and disheveled-looking man started to shout at me and threaten me. His face was one inch from mine, only separated by a thin piece of glass.
Along with his verbal threats, he started to beat on the door, and I could feel the vibrations inside my chest. I wanted to escape but felt frozen. My heart was racing, and I was overcome by fear. Eventually, I broke away and ran down the hall. In the background, I could hear laughing. At the time, it sounded like an insane laugh reminiscent of those heard in horror movies. In retrospect, I believe it was the laugh of someone who felt he had just played the greatest joke on an unsuspecting, nosey kid. However, it took me quite some time before I deciphered that realization. I was freaked out for years, and at one point, I even had a fear that I could accidentally be locked up in a psych unit, never to escape.
Our family has an intuitive psychological understanding, which stems from my mom. However, I never thought of pursuing psychology in any form. I was a science guy and never took a psychology course as an undergrad.
Medical students rotate through all of the specialties as part of their training, and at Northwestern, all M3s are required to do a 6-week general psych rotation. This rotation was a low priority for me, and my main concern was completing it as simply as possible. I wanted a site close to Northwestern’s downtown campus for convenience and picked the least desirable one because it was only a block away. I knew I would get it because no one else would want it. It was a drop-in center for the sickest psych patients, the most chronically ill. There, they could socially mingle, play a game, attend a group, get medically seen, and renew their prescriptions. Fellow students told horror stories about bizarre behavior and poor hygiene. No one wanted that rotation, so I picked it. I could survive anything for six weeks, and I wouldn’t have to travel to a distant site to complete my obligation.
My first day was as expected: bizarre, often disheveled individuals milling about, talking, and sometimes shouting to themselves. Mismatched clothes, sometimes garish makeup. “It is only six weeks out of my life,” I told myself. “I’ll do this one day at a time.” I had many obligations at that place, from doing initial psychiatric evaluations, to being a group therapy leader, to helping manage meds, to injecting patients with long-acting antipsychotics. However, I also had more free time than was typical for a clinical rotation. I started to hang around the day room. Sometimes, I would sit in the day room and read; at other times, I would play a game with a client. Eventually, something strange happened. Patients would come up to me and start a conversation. Those conversations were not about meds or the latest therapy; they were about their lives, hopes, and dreams. They would ask me about me, not in an intrusive way but in an interested way. I was becoming part of their group. They seemed to look forward to seeing me.
One day, a client could be rational, on the following day, completely psychotic. As they gained trust in me, they let me into their life, and I developed an admiration for them. Despite having constant hallucinations and delusions, many could still navigate the world, form relationships, and problem-solve. I would lack these abilities under such circumstances. Many lived a life of scorn and rejection, yet many of their desires were no different from mine. They wanted to connect with others, have value, and have those basic needs that we all require. In this crazy setting, I was doing what I wanted: helping someone improve their life, even if it was just a tiny bit. Knowing the biochemistry of psych meds helped, but just relating to them as human beings was just as important. I looked forward to showing up, playing a game of checkers, or talking to them about their past and present lives. I always felt different growing up, but kind individuals seemed to find me and convinced me that being different was OK.
Here, I was dealing with people who had problems very different from mine, people who were very different from me, yet all I could see was how similar we were underneath. These were human beings, not trash. They deserved to have the best life that they could. I felt called to spend time with them.
Once again, my logic, planning, and goal-setting were about to be tested. I had so much training in hard science, but much of Psychiatry was soft science. However, my course of action was right before me and couldn’t be ignored. Hard science told me that I could use powerful drugs to block dopamine receptors and reduce psychotic symptoms. However, soft science showed me that listening and relating to another human could be even more powerful. My beliefs were being challenged, but I was willing to listen. But was this experience a fluke? The only way to find out was to test the hypothesis, and I did that by picking psych electives that were completely different from my drop-in center experience. I did, and my mind did not change.
And so it started: residency, becoming chief resident, jobs, co-founding a clinic, working with the underserved, then… then…then.
Do you ever think there is some guiding force beyond yourself that directs you if you allow that direction? A guardian angle? God’s direct interest in you? Some other force. Despite all of my planning, logic, and science, my best decisions in life seem to come from outside of me. Interesting, no?
I spent many years sitting at this desk in my co-founded clinic.
Freddie Nietzsche has referenced the impact of life’s difficulties in a much more eloquent way than I ever could, but with that said I do have the ability to turn something negative into something positive.
I have mentioned my dyslexia in the past, but I think it deserves re-referencing here. As some of you know, I was unable to read in second grade. My teacher told my parents that she thought I was very bright and attributed this inability to poor vision. My parents took me to an optometrist who prescribed a very weak eyeglass prescription. I guess optometrists have to make a living.
My 7-year-old expectations were dashed when I put on the specs only to discover that I was as illiterate as before. The fear that my parents would be angry at me pushed me towards a solution; I created my own method to make sense out of the jumble of random symbols that my mind was seeing. I feel that my alternative way of reading has given me an advantage. I may read slower than many, but I have superior comprehension. Beyond comprehension, I appear to have an excellent ability to understand the subtext and sub-connections in a written piece. My reading difficulty turned into a reading advantage for me.
I apply this concept to other aspects of my life; most recently to the subject of backpacking.In a past post, I wrote about my trip to Glacier National Park, and how it had a life-altering impact on me. A subplot in this post centered around backpacking.
I enjoy day hiking, but I declined an offer from my friend, Tom to backpack with him. Tom is an inexperienced backpacker who challenged himself to hike in the backcountry armed only with knowledge from YouTube videos, and a healthy cash donation to REI.
His 4 day/3 night trip turned into a 6 day/5 night experience due to dehydration, electrolyte imbalance, and physical exhaustion. Despite these barriers, Tom succeeded in his quest and enjoyed the experience. Further, he feels that he bonded even closer to his son, as they had to work together to accomplish their goal.
I am happy for Tom’s accomplishment, but I am also grateful that he brought me a wealth of information on this topic. I had thought a lot about backpacking and read extensively on it, but third-hand data can only yield so much real-world details. Through Tom’s narrative, I was able to get an up-close understanding of the experience. What were the primitive campsites like? How did he go to the bathroom? What would he change in future hikes? What were the positive things about the experience? What gear did he wish he brought? What equipment that he brought was unnecessary? It is one thing to watch a YouTube video from an athletic 25-year-old backpacker, it is another thing to listen to a 52-year-old guy’s first time out. Tom’s story gave real context that allowed me to visualize myself in his situations.
My personality is such that I get enjoyment from learning information and skills. As a new area of interest, the topic backpacking offers both opportunities. Additionally, my solo day hiking trips revealed something about myself that surprised me. Despite being a loner, I very much wanted to share my experiences with someone else, and I wanted to do that sharing in the first person.
I already had a sleeping bag, and I decided to buy an inexpensive lighter weight tent. Other small purchases followed: a blowup pillow, Smartwool socks, a better headlamp.
My next phase was to try out new behaviors in a controlled environment. I set up my little tent in the living room, unrolled my sleeping bag, and climbed in for a nap. Success!
Setting up my backpacking tent in my living room. Making sure my sleeping bag fits (and taking a little nap).
When Tom came off the trail he gifted me all of his Mountain House freeze-dried food with the statement, “I’ll never eat that stuff again!” I have eaten MH on occasion and found it reasonably palatable. However, Tom ate Mountain House for all of his meals, and quickly became sick of his soft and lukewarm diet. I would likely have a similar reaction, and so I have been exploring other simple backpacking meals. In fact, I have created a few homemade “freezer bag” meals that my official tester (my daughter, Gracie) said tastes better than the commercial stuff.
Trying to rehydrate pasta and my own dehydrated veggies. Rehydrating commercial freeze dried veggies. Making my own freezer bag meals that will be compared with a MH meal.Thanksgiving dinner in a freezer bag. Just add hot water and wait 10 minutes! My meal rehydrated.
The next phase of my experiment will be to attempt a backyard sleepout. I’m curious if I’ll be able to stand up straight after sleeping on the hard ground all night. Pending the weather forecast, I will likely do this in the next few days.
So, will I backpack? Unfortunately, I have run into some pitfalls in advancing this process. My goal was to do a three-night hike with Tom next summer when he travels to Yellowstone National Park. When I mentioned this to him, he was receptive but informed me that he was thinking about a 5-6 night adventure rather than a 3-night trip. This long trip would not be wise for me based on several factors. Tom is younger than me but in similar physical shape. Despite drinking a lot of water, he became dehydrated, and due to the sequelae of electrolyte loss simple movement became difficult for him. It is also clear that he became physically depleted after day three of his hike; this was his energy limit based on his level of physical conditioning. Any additional days became ordeals for him to conquer rather than enjoy. I would likely have a similar experience. Lastly, the way that he coped with this exhaustion was to lengthen his trip, advancing his adventure from 4 days to 6 days. This expansion would be multiplied with a more extended trip. For instance, a 6-day trip could turn into 9 or 10 days. Based on all of this, it would be foolish for me to consider such a long hike. I did suggest to him that we go on a few short local overnighters, which would allow me to check out my ability in situ, but as of this moment, he isn’t too interested.
What about other options? It would be great to hike with my son, Will, but he has no interest. Julie has never expressed a desire to go backpacking. My other kids are busy with their lives, friends, and activities.
I am starting to explore the option of an organized club or Meet Up group, but I wonder if the cohorts would be too advanced for me. I have even pondered finding someone on Craigslist, or some other public forum. What would I say in an ad? “Wanted a middle-aged or older guy who has never backpacked who would like to go backpacking with someone equally inept.” For some reason, I don’t think I would get a lot of takers.
At this point, I am enjoying learning about a new topic and testing out new skills. If this hobby advances further, all the better. With that said, I believe that learning new things is always useful, even when the knowledge doesn’t have an immediate practical purpose. Seemingly specific information can often be generalized. For instance, my ability to develop decent freezer bag meals is directly related to the many years of hotel room cooking that I did when I worked 2 days a week in Rockford.
My goal is to enjoy the journey and not negate the process by only focusing on the end game.
Today I told you about my backpacking transformation, but the same techniques can be used when dealing with much more difficult problems. In fact, these rules also apply to other issues, even trauma. There are several factors necessary to turn an unwanted experience (a negative) into one that is desired (a positive).
1. Understand the process.
2. Explore the pitfalls.
3. Practice the behaviors.
4. Evaluate if the overall outlay of time and energy are justified.
This methodology works, and so I thought I would pass the tips on to you.
If I were a car, I would probably be a minivan. Sensibly designed with just enough flash to make me interesting. Ferrari’s are exciting, but if you need to get the job done you hop into a reliable and roomy Honda Odyssey.
Are you a person who likes to fly by the seat of your pants? I don’t fit into that category, I’m a planner and a tester.
A few months back my friend Tom and I installed a mains power port on the side of my campervan, and in the weeks afterward I created a simple power distribution system for the vehicle. However, I never operated it.
Dear readers, a Midwest October is upon me; perfect to do a little van exploration. With nighttime temperatures in the high 20s (-2C) it was time to test several different camper systems.
Early yesterday I pulled out the 30 Amp extension cord from the camper’s storage bin and attempted to connect it to the van’s receptacle. Crap! It wouldn’t go in. The pins on this type of plug are circular, and with some study, I was able to determine that they were slightly out of alignment. A little bending with my multi-tool and the plug slid in and mounted.
I went back into my van’s storage and located the $16 Walmart electric heater that I had purchased a few weeks earlier. I plugged it in, turned it on and… it worked! I was then off to the basement to find my 25-year-old sleeping bag. It is old and flattened, but it is also extra-long and thereby perfect for my 6’3” frame.
With heater and bag in place, I was ready to do a test run. The wilds of a National Park, you may ask? No, my driveway, of course! When I told Julie about my plans to sleep in the driveway, she nodded in acknowledgment. After 25 years of marriage, she didn’t feel it necessary to comment on the absurdity of my vision. My more adventurous friend Tom thought that I should try to sleep in the cold with the heater turned off. Likely, as some sort of manly exercise. It should be noted that Tom possesses an ultra high quality and very warm REI sleeping bag, as opposed to my 25-year-old “pancake.”
As bedtime approached, I gathered my camping essentials: water bottle, laptop, and iPhone. I traversed the 30 feet from my front door to the camper and entered with anticipation. It was cold! On went the electric heater powered by my garage’s outlet. I reached down and powered up the van’s 12V power system, and then flipped on its interior lights.
The heater seemed anemic, and I thought I would be spending the night freezing. But, in short order the van warmed up. I settled in my sleeping bag, fully dressed including a stocking cap. Like any other wilderness he-man, I opened up my laptop and checked Facebook, braving a weaker wifi signal from my house.
I worried that I wouldn’t fall asleep, as I fell asleep. Comfortable, warm, sleeping in a van parked in my driveway Silly for Dr. Mike, a 65-year-old physician, exciting for the 9-year-old Michael inside of me.
The outside temperature dropped to 29 degrees, but my little heater plugged on. In fact, I had to turn it to low in the middle of the night because I was getting too hot.
I write this the next morning after following my tradition of walking to Starbucks. Here I sit at my usual table, typing and sipping coffee. Mission accomplished.
My adventure may seem childish to you, or it may not. However, it was fun and informative for me. I tested out several of my camper’s systems and felt the security of reassurance. I had a “backyard” camping adventure. I had a good time.
Dear reader, so often we get locked into doing only “appropriate” behaviors. We don’t allow ourselves simple pleasures because we have deemed them childish. We criticize our children, “You are too old to do that.”
I am here to tell you that it is OK to explore the child in you because that is the part of you that still possesses wonderment. I challenge you to rediscover that aspect of you. I believe that you will grow just a little bit more in the process.
My $16 Walmart heater, and 25-year-old sleeping bag.
Why is it that I can focus on a single negative in my life while ignoring so many positives? How can I change this waste of energy?
I think my thinking pattern is similar to many others. I can let a single worry dominate me. Typically, I find that this stance is a waste of my time and energy. Yet, I continue to do it.
I have made attempts to change my behavior, and some of my efforts have been more successful than others.
I have gotten better at letting go of trivial slights. The driver that cuts me off no longer spoils the rest of my morning.
I also employ cognitive techniques to correct my perceptual distortions. When I get upset about something, I will pull back and logically explore the problem and reframe the information at hand in a more realistic way and less catastrophic way.
Also, I work hard to let go of situations that I have no control over. I’ll, “Let go and let God.”
The above techniques all fall into what I would call a pathology model. In other words, they focus on lessening my current worries. The problem already exists, and so I actively treat it.
Good doctors not only treat problems they also practice preventive medicine. I would like to think of myself as a good doctor and what I advise my patients can also apply to me. So how do I prevent worry? There are many ways, but the one that I would like to share with you today is called a gratitude list. This technique is simple, but it does require some practice and thought.
The positives in my life far exceed the negatives. However, I can take my blessings as expectations and thereby ignore their significance. A gratitude list is one way to acknowledge these good things, and when I do this, I automatically have a more positive outlook of my life.
Here are the steps I use.
-Once a day I think of 3-5 things that I’m grateful for. They can be significant things or minor things. For instance, I might be thankful for my health (major thing), and I also may be grateful for having coffee with a friend (minor thing).
-I make an effort to vary the things that I’m grateful for. In other words, I don’t repeat the same list every day.
-Sometimes I’ll write down my gratitude list, sometimes I’ll only make a mental note.
-I don’t just write down a list, I also think about each example on that list. I may recall that I’m no longer on any medication and that I’m able to walk long distances once again. I might think about a walk that I took and how much I enjoyed it. For my second example, I may be grateful for having people in my life who want to spend time with me. I might remember the conversation that I had during my coffee klatsch, or how much I enjoyed the taste of the coffee.
-If possible, I recall my gratitude list during the day, repeating the above technique.
When I first started this daily exercise I had trouble coming up with unique things to be grateful for. However, over time, it became easy. The trick is to limit your list to a manageable number. I find that 5 examples works for me. I want to have time to think about my list, I don’t want to write down a lot of meaningless examples.
By doing this exercise regularly, it has become evident that I have much to be grateful for. When I think about my life in positives terms I feel more positive about myself, I attract more positive people, and many of my problems feel more trivial. All of these benefits for the cost of a little time!
I would encourage you to make a gratitude list every day for the next 30 days. Let me know if it makes a positive difference in your life. If the answer is yes, it is easy to incorporate a gratitude list into your daily routine.
Last week I had surgery, a long surgery that required over an hour of operating room time, but the operation was not my greatest fear as I approached this process.
What concerned me the most? I feared having to get a pre-op clearance from my internist; a simple visit that would require less than 10 minutes of contact time. You may be thinking that my primary care physician is mean, rude, and evil. Of course, this is not the case. He appears to be a nice man and a good doctor. If I felt otherwise, I would not work with him.
So Dr. Mike, what is the problem? First a little more background information.
As a person who has battled obesity all of my life, I have become acutely aware of the stigma that comes with weighing excess pounds. Few human attributes can be ridiculed and condemned in the millennial “microaggression” culture of 2018. Imagine criticizing or mocking someone because of their race, sex, religion, sexual preference, gender identity, physical stature, or a multitude of other differentiating human characteristics.
Making fun of “fat people,” is an acceptable national sport, even though the CDC reports that over 70% of adults in the US are now overweight. Of course, as the overweight population explosion redefines the concept of what is normal weight, there will always be those outliers who exist beyond a standard deviation from that norm. There will always be a group to abuse with fat jokes, both overt and covert criticism, and outright disdain. If you are obese, it appears that it is OK for others to assume that you are lazy, dirty, and stupid.
We would never make such assumptions for other medical epidemics. Imagine someone undervaluing you because of your high blood pressure, or your fasting blood sugar? Just like obesity, these illness are caused by multiple factors: genetic, environmental, and lifestyle. Unlike obesity, there are good medical treatments for these ailments, making them easier to treat. The majority of folks with high blood pressure can significantly reduce health risks with medication management alone. However, the majority of obese people will continue to be fat despite diet plans, medications, exercise, and shaming television shows.
I lost over 100 pounds about 3 years ago. I did this after failing many traditional techniques of weight loss. I feel that my weight loss was indeed a miracle that was fueled by common sense, rather than modern medicine.
We are humans, not machines. We are motivated and influenced by a multitude of factors. This variability can be considered a weakness, but it should also be acknowledged as one of our greatest strengths. We are complicated, and as such simple blanket solutions have marginal utility.
Over the three years since I lost weight, I have regained a small percentage of my weight. Most people have told me that I look better with a few extra pounds. They say I look less gaunt, and more vital with this increase. Additionally, I have long shifted from judging myself based on a number on a scale. My lifestyle changes have been just that, they are not strategies to lose weight and thereby achieve some sort of false utopia. “My life will be good if I am not fat.”
Three years into this process:
I still can wear my same wardrobe.
I still exercise every day, walking from 3.5 to 8 miles.
I still avoid all forms of concentrated sugar.
I still practice healthy eating.
I still make an effort to eat more natural foods.
I still assess and correct hidden forms of weight gain, like emotional eating.
When I determine my current status I would say that my efforts continue to be successful, but what about the matter of my small weight gain, does this one objective parameter signify failure? I would say, “No.”
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I sit in a chair opposite from my primary care doctor who is staring at a computer screen.
“You have gained weight.” My doctor says. My initial impulse is to apologize for my failing. I resist. My second impulse is to defend my position. I resist and remain silent. “Are you exercising?” I reply that I am and had already walked four miles before our appointment. “But what about cardiovascular exercise?” He retorts. And so it went. Three minutes of questioning that felt like three hours of interrogation. Pain always feels worse when inflicted on an open wound.
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Dear readers, I’m am a resilient person. Besides, I am good at using the counterbalance of logic when dealing with my emotional exaggerations. However, there is more to this story than just a detailed account of me stepping on the scale and my emotional response to that event.
Being a physician, I understand the power that doctors have over their patients. Patients come to us in an extremely vulnerable state looking for help. Studies have shown that a statement like, “You need to quit smoking,” will convert some active smokers into former smokers. Unfortunately, in medicine one size does not fit all. It is easy for physicians to generalize the above truth and think that simple pronouncements can be used to motivate all lifestyle change. However, a doctor’s command is a partial solution at best, and should only be used when wielded within a broader understanding of what causes people to change.
Many of the illnesses that physicians treat on a daily basis have a strong lifestyle component. My weight loss eliminated my need for blood pressure tablets, high cholesterol medication, and a CPAP machine. So why is it that physicals don’t learn and employ simple motivational techniques so they can move their patients towards health? I don’t ascribe to know all of the answers to this questions. However, I do know some of them.
Physicians in the US work in a production model. We get paid by the volume of the work that we do. See fewer patients, make less money. As medical practices get bought up by business investors the push for physicians to do more continues to increase. A good business model consists of finding ways to spend less and make more. This fact is contrasted by a simple truth; we are caregivers, and most of us want to provide care.
Our contact with patients is reduced by the use of physician extenders. Someone else takes our patient’s blood pressure and obtains their chief complaint. We employ electronic medical records (EMRs), which provide a clear notation of our treatment plan, but does so at the cost of patient interaction. Patients now have the “privilege” of answering our questions as our eyes are focused on a computer screen instead of them. Patients want care from us, and we want to meet their needs. There is a pill for everything, and today’s EMR makes prescribing absurdly easy. Is writing prescriptions the same as providing care? I believe that it is only a part of our job, and it should not define us in total.
When I retired from private practice, I was fortunate to have patients write goodbye letters to me. Almost universally they said that they valued their time with me because I listened to them, didn’t judge them, and guided rather than controlled them. To do these things I needed to spend time with them. I would have made more money if I saw 6 people in an hour, rather than the two that I scheduled. However, I would not have known my patients as well, and more importantly, they would not have known me as well. Trust is a function of integrity multiplied by time. Trust by itself offers a positive corollary to patient satisfaction and well-being. Besides, a career that includes connecting with others is eminently more satisfying to we providers than one that does not. A win/win.
One factor needed to motivate change is time. Unfortunately, extending the length of appointments may not be possible in today’s corporate medicine climate. There are indeed a variety of stop-gap strategies that doctors can do to build a connection, such as deliberately spending a few minutes directly with the patient before turning to a computer screen. Such simple changes can make a patient feel more connected, but they still don’t address the elephant in the room.
How should doctors interact with patients to create change? Fat people know that they are overweight, and should lose weight. Alcoholics know that they drink too much, and should stop. Diabetics realize the importance of blood sugar control, and that they shouldn’t eat that extra donut. We live in a culture that shames, and it is likely that some will avoid being humiliated by their physician by avoiding seeking necessary medical care. I admit that I have been an avoider in the past.
Big problems become smaller when shared with someone. I am willing to tackle projects that I would not usually attempt when I have someone at my side. This phenomenon is even more evident if that “someone” has expertise that I lack. If you have been reading my prior post, you know that I have been converting a cargo van into a camper. I dare to significantly modify my van because I am doing the project with a friend who has expertise far beyond mine in such manners. We, physicians, have expertise far beyond our patients in such manners as health. Most reasonable patients accept this, despite the advent of the Internet. A colleague of mine has a cup in his office that reads, “Please don’t confuse my medical degree with your Google search.” However, most patient’s intrinsically understand our expertise, which is why they are seeing us.
Doctors need to connect with their patients as human being to human being, and they need to do this on a level that patients can relate to. We need to become trusted knowledgeable friends rather than overbearing, critical parents.
We need to understand where our patients are coming from, and how willing they are to make change. We need to problem solve with them. Imagine if my doctor asked me, “Are there any barriers that prevent you from seeking medical attention?” Or, “Are there any ways that I can help you with your lifestyle change?” Those simple questions would instantly change my relationship with my care provider. I would want to meet with him, and I would look at setbacks as problems to be solved, rather than justifications for criticism.
Once a patient’s cards are on the table, all things are possible. Is the doctor’s goal the same as the patient’s? What are the barriers to achieving the desired goal? What steps should be tried? How will progress be measured? How is a reversal of progress addressed? Empathy joins, criticism divides.
A meaningful connection with a patient doesn’t happen all at once. Relationships develop over time. However, imagine helping your patients make a significant and real change. Imagine the satisfaction of having a substantial connection with them. What would it be like to work with real people instead of being a reviewer of lab data? What would it be like to end your workday with the knowledge that you truly connected with someone in a meaningful and significant way that changed their life? What would it be like to move from treating diseases to treating people?
We blame our patients for their failings, while we steadfastly hold on to methods and techniques that simply do not work. Imagine if our relationships with our patients were more as a knowledgeable and caring peer rather than a stern and critical parent? Imagine yourself as the patient. You are aware that you have a problem and you need help. Who are you going to ask? Someone who tells you what you already know, makes you feel bad, and offers no real help? Probably not.
Life doesn’t always turn out the way that you expect it to. This is the story of Kathy.
Kathy sits across from me sipping a herbal tea, at 71 she is active and tells me that she is going dancing after our interview. Kathy has been a widow for 4 years, and she is trying to adjust to her new life.
She met her husband at a dance when she was 19. He was the older brother of one of her friends, and after the dance, he got her phone number from his sister.
Dave asked Kathy out on their first date by posing her a question. “If you can tell me the color of a red pencil, then you can go out with me.” She liked her husband Dave because he was smart, funny, and a little sarcastic. “I got tired of the sarcastic part pretty early on, and I let him know that.” Dave had a significant limp from a bout of childhood Polio. He was born before the advent of the Polio vaccine and contracted the disease as a baby. Growing up he worked hard to compensate for his handicap by regularly working out in his homemade basement gym.
On the surface, Kathy felt that they were dating casually. However, six months into the relationship she ended a connection with another man. Clearly, there was a part of her that knew that there was something special about her future husband.
She was still in school, and Dave returned to college studying at Lewis University. Kathy recalls a letter that he sent her around their 3 month anniversary. In the letter, he thanked her for the brownies that she made him and told her that he would also like some cookies. Although humorous, that simple comment foretold of things to come.
They had little money, and it took them 6 years to save enough to get married. Dave eventually became a special education teacher, and Kathy taught elementary education, both for the Chicago public schools.
They saved and bought a home on a large lot in the country. They traveled a bit. They raised a family. This was the American dream of the 1980s. Dave loved to eat. In fact, Kathy says that he was obsessed with eating. Dave started to gain weight and went from thin to morbidly obese. Along with his obesity came diabetes. Along with diabetes came diabetic neuropathy. Along with diabetic neuropathy came immobility. He was already limited by the aftermath of his polio, but his neuropathy made him disabled. It became difficult for him to walk or maintain his balance. This made it hard for him to contribute in a meaningful way at home.
Slowly, but progressively, more and more of the home tasks fell on her. This is how she describes a typical morning in those days:
“I would get up at 4 AM and walk the dog. Then I would throw clothes in the clothes washer, and empty the dishwasher. In those days I made a lot of oven breakfasts, and so that would be cooking. After breakfast, I would get my kids ready and drive them to school or the sitters. Then I would go to my full-time teaching job.”
Kathy was feeling tired and stressed. Despite this, she put one foot in front of the other and pushed forward. “I didn’t think about it, I just did it.”
Dave’s condition continued to worsen and his doctors came up with a new diagnosis, Post Polio Syndrome. Post Polio Syndrome is a syndrome that occurs many years after a person has contracted Polio and it is characterized by muscle weakness, fatigue, and pain. Dave went from using crutches to being a wheelchair user in 1996. It was becoming increasingly difficult for him to get out of the house, and once out he could only go to handicap accessible locations. This was not only difficult for him but his entire family.
Kathy continued to push forward, but her life was becoming further limited, and she was avoiding social gatherings because of the enormous difficulty in transporting Dave. Her world was closing in.
In 2009 she started to notice another change in Dave, he was beginning to stutter. Dave was a bright and inquisitive individual, but now his logic seemed way off. Simple things, like learning how to use an electric wheelchair, were beyond him. He was complaining of vision problems, although his eyes tested OK. He had trouble writing. In 2011 an ophthalmologist examined him and thought that he may have Parkinson’s Disease which can be confused with another illness called PSP. Dave was seen by a Neurologist who did an MRI of his brain. That test showed an unusual hummingbird pattern which is the classic sign of PSP or Progressive Supranuclear Palsy, a disease that destroys part of the brain. This explained the stuttering, lack of coordination, problems with logic, and the fact that Dave had gone from being a nice person to a nasty one. Dave started to show a lack of empathy, and at the same time, he was becoming progressively needier. If Kathy was out of his sight for a moment, he would bang on the walls or call her cell phone to get her attention.
She now had caregivers coming in, but they were only present 3 hours a day. “Sometimes that was the only time I could sleep as Dave would often be up at night.” Another symptom of PSP is dementia. Kathy’s situation was similar to someone who had a spouse with Alzheimer’s disease. It was a tough time. She had discovered a Facebook group for PSP caregivers, and that served as a lifeline for her. “Connecting with other caregivers, I started to understand that Dave’s behaviors were due to his disease.”
The course of PSP runs from 6-15 years, and on August 17, 2014, Dave passed away at home.
Kathy spent much of her marriage taking care of Dave, and through the process became ever more isolated from the outside world. A part of her wanted to live, to experience, to explore. In many ways, she was like a person who had been released from prison after spending 20 years in confinement. She had a desire to move forward, but her life had been so structured that she didn’t know how. “My friends in the PSP group talk about this. That first year is go, go,go. It is like you are trying to make up for all of the years that you couldn’t do anything. You move forward, and you make mistakes. I joined a dating site, but I didn’t understand that there are predators that lurk on these sites. Let’s just say that I got hurt.”
Kathy continues to move forward, but at times it is difficult to know what forward is. She is starting to do things for herself. She travels more, she has joined a gym, she is taking dancing lessons, she casually dates, she learned how to swim, she learned how to ride a horse, she is a regular at a senior MeetUp group. Despite this she is lonely. She has gone from being a caregiver to being free. However, being a caregiver was her identity. She has lost her identity.
“I decided that it was time to talk to someone who could help me figure out where I go from here. I need to accept that fact that I may never have another partner. I need to be happy with myself.”
Kathy says that she is still a work in progress. She continues to expand her experiences, but at a less frantic pace. She is enjoying her friends, family, and grandkids. She continues to learn and grow.
We never know where life will take us. Every day is a gift. Good days have bad in them. Bad days have good in them. It is our task to extract what good that we can from every day, as we will never be given that day again.
Kathy is a heroic person who is trying to live by that philosophy. I wish her well.
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